Shapiro, Alexander or Keene

[apamin]

I am from Phoenix, AZ and have been doing a lot of research and am narrowing down my list. I am wondering if you were in Phoenix who would you choose out of the three for FUE and why? Alexander is local, Keene is a 2 hour drive and SMG would require travel. Thanks in advance! I really appreciate this site and what it has done for the community!

Edited April 18, 2014 by apamin
add fue

[Mickey85]

For strip, out of the three, for me, Shapiro hands down. Far more prolific than the other two and I would not go to Keene under any circumstances due to what I perceive as a lack of ethics on her part(operating on 19 year olds).

 

If you want FUE(as you posted this in the FUE section) I would travel to Europe as the likes of Lorenzo, Bisanga, Erdogan, Mwamba, Maras etc are much more adept at FUE than the North American surgeons, in my opinion anyway.

[Spanker]

Shapiro

[Mickey85]

OK since you added that you want FUE, I will reiterate that I would travel to Europe instead.

[Janna]

For strip, out of the three, for me, Shapiro hands down. Far more prolific than the other two and I would not go to Keene under any circumstances due to what I perceive as a lack of ethics on her part(operating on 19 year olds).

 

 

 

I've worked for Dr. Keene for many years.... she is considered one of the most ethical physician in this business. Does she routinely do 19 year olds? Do you know the specifics of that particular case?

[hsrp10]

SMG all the way, if you're gonna fly then that also expands the options to Konior and Hasson

[hsrp10]

if you want FUE yeah then Europe is the place like Mickey added

[Mickey85]

I've worked for Dr. Keene for many years.... she is considered one of the most ethical physician in this business. Does she routinely do 19 year olds? Do you know the specifics of that particular case?

 

I already talked about this in the thread that was locked. In my opinion, someone as young as 19 should never be worked on Janna, unless they have pre-existing scarring or disfigurement(burns, accident etc). I don't care who the surgeon is, NO one can predict where a 19 year olds hair loss will stop. Surgery is a serious undertaking, donor hair is finite, visible scarring can occur and 19 year olds generally do not make the wisest of choices. That younger the patient, the harder it is the determine a gameplan, the higher the risk of future loss. That is my opinion. Everyone can make up their own mind on whether operating on a 19 year old is ethical or not. In my opinion, the patient should not have been operated on due to a myriad of reasons. If someone has serious image issues and is severely depressed(due to their hair or otherwise) they should be turned away and recommended to a therapist. Especially at 19 years old because the potential for future loss is unknown and very unpredictable (even with Proprecia and Rogaine) and surgery is a serious decision that younger guys tend not to think about.

Edited April 19, 2014 by Mickey85

[orlhair1]

You will be happy if you decide to go to SMG.......great clinic!

[apamin]

Thanks for the reply's! The more I read the more confused I get. I am 35 years old and want to do it right the first time rather than wish I had after the fact. Are the surgeons in Europe really that much better than ones in the US? Wasn't the FUE procedure invented by Feller (US). Just trying to see if the difference is that big by going to SMG vs Fuller vs Europe, etc. Thanks!

[Mickey85]

Thanks for the reply's! The more I read the more confused I get. I am 35 years old and want to do it right the first time rather than wish I had after the fact. Are the surgeons in Europe really that much better than ones in the US? Wasn't the FUE procedure invented by Feller (US). Just trying to see if the difference is that big by going to SMG vs Fuller vs Europe, etc. Thanks!

 

No, Feller did not invent the FUE technique. An Australian surgeon invented the technique but has since been left behind and superseded by the likes of Bisanga, Lorenzo, Feriduni, Erdogan etc. I haven't seen a Feller FUE result in years. He used to do very small sessions.

[Mickey85]

Thanks for the reply's! The more I read the more confused I get. I am 35 years old and want to do it right the first time rather than wish I had after the fact. Are the surgeons in Europe really that much better than ones in the US? Wasn't the FUE procedure invented by Feller (US). Just trying to see if the difference is that big by going to SMG vs Fuller vs Europe, etc. Thanks!

 

In my opinion(I'm sure others will disagree), the European surgeons in general have a much better grasp on the FUE technique. Lorenzo, Bisanga, Feriduni, Mwamba, Erdogan, Maras etc have all become very proficient at FUE, enough that the yield rivals that of strip. Feller did not invent FUE, an Australian surgeon(who cannot be named) invented FUE but has been superseded in skill by the aforementioned European surgeons.

[apamin]

Thanks for the reply! I gotta admit that I am not sure what to do now. I had a consult that recommended 2000 with ARTAS and another that said 1500 with SAFE. I think I need to take my time and determine the very best option. For the ones that you named above, who is logistically easier to go with in terms of consults, travel, availibility, etc. I really do want to go to the best of the best but at the same time I do not want to have to jump through hoops just trying to get a hold of them. I appreciate all the reponses, everyone has been very helpful. I am attaching a few pics of my head so that you can see what I am working with.

[Mickey85]

I don't think 2,000 grafts will give you a complete look at all... Let alone 1,500 grafts...Lorenzo is in the UK and I think his schedule is pretty easy given he located to a totally different country, when he was in his home country there was at least a one year waiting list. Best consult with each surgeon to see their approach and availability.

[GBU]

Keep us posted on your research . I personally have no confidence at all with ARTAS . Mickey85 has some good suggestions .

[Hairtechnician]

Mickey85,

 

Yes, we have discussed your opinion about Dr. Keene's choice to perform surgery on a 19 year old elsewhere, but since you are posting defamatory remarks about Dr. Keene in this post also, I feel the need to repost her response to your prior inflammatory statements. First and foremost, Dr. Keene does not perform surgery on someone who she feels will not benefit from it, period! The patient seeking opinions in this case is 35 years old, so your opinion regarding Dr. Keene's choice to do surgery on a 19 year old does not seem relevant to me, but since you stated again that you feel Dr. Keene's choice to do surgery on a 19 year old means she is not ethical, when she is an extremely ethical and caring doctor, I feel the need to repost Dr. Keene's responses regarding your statements.

 

 

"The difficult thing about patient blogs is that protecting the privacy and anonymity of those who post can obscure or obstruct the knowledge of clinical nuances that contribute importantly to medical decision making. Likewise, the anonymity of those who respond, can cloud or camouflage a clinical bias which may not be based on scientific knowledge or expertise. In hair restoration, as all disciplines, expertise and training in the medical specialty are important. A doctor/surgeon must insure that all aspects of the medical history and hair loss history are part of the decision making process. It does not serve a worried patients interest to criticize their surgeons decisions, without being aware of all information—and can in fact unnecessarily increase or even cause a patients anxiety. Bloggers who request information, in my opinion, are best served when other patients share their experience of how to deal or improve a particular problem. This online environment should be a supportive one, and help guide fellow patients through a temporary anxiousness or to ask their doctor the appropriate questions if they need to. I have had patients share that experience from this website, and appreciate it.

 

In my over 20 years of performing follicular unit transplantation , I have operated on a handful of patients under the age of 21, and only a small fraction of my overall patient population are under the age of 25. A decision to proceed with surgery at a young age must include a thorough understanding of the progressive nature of hair loss from androgenetic alopecia (AGA or male pattern baldness)—but if in my clinical judgment, after weighing the pros and cons, I think it will benefit a patients life and livelihood I have on occasion, been willing to do so. It is more customary for me to prescribe medication to stabilize a patients pattern. However, when I know the medication is not likely to achieve a goal that I think is reasonable, then surgery may be the best approach. Without violating the privacy of the patient which prompted my response, I would like to share the stories of a couple other patients who did not blog but were very young when they had surgery—their experiences changed my perspective. In the first 5 years of my career in hair restoration, I adhered strictly to the “rule” that no patient under the age of 25 should have surgery, as they won’t be able to predict their future pattern. During that time finasteride was not yet available, but furthermore, even with the benefits of medication these drugs cannot typically restore hairline areas that have receded….and can be the source of significant anxiety to many young men.

 

Several years into my career, I was approached by a mother about her 20 year old son, who refused to attend family functions, refused to be included in family photos, and refused to be seen without a baseball hat because he had lost a considerable amount of frontal hair and had no distinguishable hair line. He sat in my office with his mother as she shared their story, but when I asked him if he felt the hair loss was interfering with his life, he looked down at his hands and stated firmly that this was all his mothers idea, he was fine with his hair loss. I explained to his mother how I could not recommend surgery to anyone who did not wish to have it, and the patient indicated he would be fine to proceed if it would make her happy. I felt ambivalent, by her report his hair loss was causing extreme self consciousness—by his, he was not at all disturbed by it. I spent a great deal of time explaining the benefits of medication therapy to stop future hair loss and suggested if he was not bothered by his hair loss there was no real rush to proceed with surgery at his young age—that in fact he would benefit from knowing if the medication might strengthen some of the thinning areas. I did express concern that something was causing his unwillingness to attend social functions, but the patient was adamant it was not his hair. A few months later he came back in for a follow up appointment; I was surprised to see him on my schedule as I did not expect him back for a year. When we spoke he felt his hair loss had stabilized, he was no longer shedding, and reported to me that he still wasn’t bothered by it. I told him I thought it was fine to continue on medication and he could always consider surgery at a later date if he ever changed his mind. Peculiarly, I received a call from his mother about 20 minutes after he left the office—she was calling to schedule a date for his surgery. I shared with her that her son stated he was fine with how he looked—and she stated he was the one who called and asked her to schedule. I felt perplexed, but assumed that despite his revelations to the contrary, she knew it was affecting him and he was willing to let her help him—even if he did not wish to admit it to me. I do my best to make patients feel comfortable, but when a parent comes to my office with their child, I know they have their child’s best interests at heart and are looking for me to help. A year after his surgery, his mother shared how his life had changed. He had become very social, he no longer wore a hat, he attended family functions again, had a girlfriend, and had experienced great success in his work which involved sales. When I saw him in my office, he looked me in the eyes, not at his hands…and though by then he was only 21 years old… I knew we had made the right decision. Although it has been some years since I have seen him, I did see him for several years after his surgery and we did eventually do a second procedure to strengthen his density and fill in for a little bit of additional hair loss—though the medication seemed to be holding him quite well. Furthermore, the permanent hairs in the front, allowed him to cover areas behind it which were slightly thinner.

 

A second case I will share is similar in nature, except that there was no parent involved. A 22 year old young man came to me to ask me to fill in his hair line. We discussed the risks of advancing hair loss, which might be stabilized with medication—but there was no certain way to know that until more time had passed. So he began medication therapy, and a year later when I saw him his pattern had stabilized. He asked if I would do surgery, and I said we needed to wait for another year to be sure he was stable—this happened the next year, too. At the “magic” age of 25 we operated and filled in his hair line—and when I saw him back several months later he looked younger than when we first met. He was thrilled, glad to be getting carded again…and while I was happy for him, I thought about the 3 years I had refused to operate on him…with the wisdom of hind sight, I knew he hadn’t benefitted from that lost time—his pattern was stable on medication and from experience, I could have predicted that after about 6 months. And even if it wasn’t completely stable, he was intelligent and educated on the subject of progressive hair loss. Knowing what the risks were—that he might some day need another surgery, he could have, and should have been allowed to make that decision—age was not the issue, since the risk of additional hair loss was still present when we operated at age 25. In fact, for men of all ages, the risk of needing to ‘chase a hair line” is present in virtually every patient we operate on who has a minimal pattern of hair loss! In order to avoid that, should we then require that all patients progress to a Class V-VI pattern before proceeding with surgery? I don’t think that is reasonable. I am pleased to say that I am aware of the happier lives of many young men, who have their confidence restored by what I do. Nevertheless, do I encourage all young men to proceed with surgery? I would never suggest it unless he had been seen and evaluated by an experienced follicular unit transplant surgeon. Because of experience and knowledge I do have the ability to know whether a patient is likely to have progressive hair loss, and whether they are likely to benefit substantially both emotionally and cosmetically. Even in cases of Body Dysmorphic Disorder, according to studies and personal directives from psychiatrists I have spoken to when faced with this issue, some patients will be cured or substantially benefitted—but not all, and a multi disciplinary approach may be necessary."

 

In another statement she continues:

 

"Self image isn’t less important at age 19, it may be more so—or at least equally so. There are reasons not to proceed with surgery at age 19, often we are dealing with the early stages of thinning, and surgery could accelerate hair loss. In these cases, which are the majority, I always recommend watchful waiting and medical therapy. Fortunately, most 19 year olds are not affected with AGA at such a young age, but when they are, every patient is entitled to be fully educated about his options, and proceed accordingly. In my experience, few young people can afford cosmetic surgery, and are usually assisted in their decision making by the wisdom of a parent. Presumably this overcomes the reported objection to allowing a young person to make his own decisions—though I will address this assertion momentarily. Nearly all young patients I have seen over the years where the option of surgery has been provided, have parents who are professionals (including medical doctors) and usually do not make this decision alone, simply as a matter of economics. My job is never to persuade a patient to proceed with surgery—at any age—but merely to explain the options they have, both medical and surgical, including the consequences of future hair loss if it occurs. Each circumstance and patient is different, and each has a right to their valid concerns and approach to every challenge, including hair loss.

 

For better or worse, the psychological literature is full of data to support that society and individuals make judgments based on the way a person looks, and this can affect the way a person is treated, whether they are 19 or 90. So it is not just self image we are speaking about, it is the way others view and treat us, too. While counseling can help a self conscious patient accept their hair loss, preventing and treating hair loss is an alternate or adjunctive approach. The more or less ubiquitous acceptance that hair loss due to chemotherapy is emotionally traumatic independent of the associated illness-- raises the question as to why anyone would think young men in particular or any man or woman who loses their hair has no right to be similarly upset, regardless of the cause. Losing hair can impact how we look to ourselves, and to others. Nevertheless, I also accept that some people look great with no hair, and for them shaving the hair off is not only acceptable, but promotes their positive self image. But this approach is not for everyone, either!

 

Returning to the subject of young men and the risk of allowing them to make decisions about treatment of hair loss can be put into perspective if we look at other decisions we allow of 19 year olds. As a society we accept that 19 year olds can make life and death decisions in defending our country through military service. We allow them to decide for themselves whether to be involved with sports, whether it be kick boxing, football or skiing—all of which can have damaging, long term effects on the body. We also allow them to decide for themselves whether they should consume cigarettes or alcohol….or get tattoos or piercings—again, all of these decisions can have long term consequences. Is it reasonable to suggest that making an informed decision about hair loss treatments is out of the question?

 

There are a variety of medical and psychological issues that can make it more or less beneficial to proceed with hair restoration surgery—at any age...every patient is entitled to their own opinion, and I listen carefully to each of them when they are in my office. If I am confident they have been fully educated and understand the long term risks and benefits of their decisions, they have a right to make them."

[Mickey85]

Cool.

[Bill - Seemiller]

For strip, out of the three, for me, Shapiro hands down. Far more prolific than the other two and I would not go to Keene under any circumstances due to what I perceive as a lack of ethics on her part(operating on 19 year olds).

 

Mickey,

 

We all know you have strong opinions. However, having met and spoken with Dr. Keene several times and having talked to and met in person several of her patients, I genuinely feel confident in both Dr. Keene's ability and ethics. While I agree in general that 19 years of age is far too young for a hair transplant, I've always believed that there are exceptions to every rule. Each patient's unique circumstances must be considered and I believe Dr. Keene did what she felt was in the patient's best interest.

 

Also, this topic has nothing to do with the case you're referring to and is only regurgitating discussion that has been completed on another topic. Please stick to the scope of each topic when replying.

 

Thanks,

 

Bill

[Since21]

Please stick to the scope of each topic when replying.

 

Bill, with all due respect, I know you have interests to protect, but let's be honest, a doctor's judgment and ethics are surely a valid part of the discussion when choosing a surgeon, and Mickey is simply stating an opinion with regards to one of the three surgeons being evaluated in this discussion. We all use other cases as a means of determining a surgeon's value.

 

What's the saying? “It takes a lifetime to build a good reputation, but you can lose it in a minute.” Sometimes it only takes one case to change your opinion of a surgeon - whether that's based on their skill or ethics. That's our prerogative as members of this community.

[Mickey85]

Mickey,

 

We all know you have strong opinions. However, having met and spoken with Dr. Keene several times and having talked to and met in person several of her patients, I genuinely feel confident in both Dr. Keene's ability and ethics. While I agree in general that 19 years of age is far too young for a hair transplant, I've always believed that there are exceptions to every rule. Each patient's unique circumstances must be considered and I believe Dr. Keene did what she felt was in the patient's best interest.

 

Also, this topic has nothing to do with the case you're referring to and is only regurgitating discussion that has been completed on another topic. Please stick to the scope of each topic when replying.

 

Thanks,

 

Bill

 

With all due respect Bill, I am sticking to the topic on hand. The OP wanted to know which surgeon we prefer, I simply stated my preferance and stating WHY I would not personally go to Dr Keene. It was not like this thread was about body hair transplantation and I brought up Dr Keene's reputation out of no where. Would you prefer if I simply stated "I would not go to Dr Keene because I don't believe she is ethical" and just left it at that? The OP asked for our opinions on specific surgeons, I gave mine.

Edited May 6, 2014 by Mickey85